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DEGENERATIVE SPINE (Degenerative Disc Disease)
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When back specialists refer to degenerative spine disorders, they are usually referring to a combination of problems in the spine that "start" with damage to the disc, but eventually begin to affect all parts of the spine.
Degenerative disc disease occurs as the interverterbral disc deteriorates. This is commonly a result of aging. Over time, repeated daily stresses and minor injuries can add up and begin to affect the discs in your spine. The disc eventually begins to suffer from the wear and tear; it begins to degenerate and loses some of its height and sponginess. The following text is a general overview of types, causes, symptoms and diagnosis of degenerative spine disorders.
Types of Degenerative Spine Disorders
Spinal stenosis is a narrowing of a portion of the spinal canal. This narrowing can result in pressure placed upon the spinal cord and nerve roots. Stenosis can occur in all areas of the spine, but it is most common in the neck (cervical stenosis) and the low back (lumbar stenosis). Also as discs degenerate, one vertebrae in the spine may slip over another. This disorder is called spondylolisthesis.
Detailed information on these disorders including treatments and case studies is provided on the following pages:
Anatomy and Function of the Spine
To better understand how disc degeneration occurs, it is helpful to know some anatomy of the spine and more specifically, the parts of the spine involved. See Spinal Anatomy for more information.
Causes of Disc Degeneration
With degenerative disc disorders, the main problem lies within one or more of the intervertebral discs. There is a disc between each of the vertebra in your spine. The intervertebral discs are designed to absorb pressure and keep the spine flexible by acting as cushions during body movement. The discs are similar to shock absorbers. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses, or provide the movement needed to bend and twist. Bones cannot sustain high stress repeatedly without being damaged. Much of the mechanical stress of everyday movements is transferred to the discs.
A healthy intervertebral disc has a great deal of water in the nucleus - the center portion of the disc. The water content gives the nucleus a spongy quality and allows it to absorb spinal stress. Excessive pressure or injuries to the disc can cause injury to the annulus - the outer ring of tough ligament material that holds the vertebrae together. Generally, the annulus is the first portion of the disc that gets injured. Small tears show up in the ligament material of the annulus. These tears heal by scar tissue. The scar tissue is not as strong as normal ligament tissue. Over time, as more scar tissue forms, the annulus becomes weaker. Eventually this can lead to damage of the nucleus. The nucleus begins to lose its water content due to the damage - it begins to dry up.
Because of water loss, the discs lose some of their ability to act as a cushion. This can lead to even more stress on the annulus and still more tears as the cycle repeats itself. As the nucleus loses its water content it collapses, allowing the two vertebrae above and below to move closer to one another.
This results in a narrowing of the disc space between the two vertebrae. As this shift occurs, the facet joints located at the back of the spine are forced to shift. This shift changes the way the facet joints work together and can cause problems in the facet joints as well.
Bone spurs, sometimes called osteophytes, may begin to form around the disc space. These bone spurs can also form around the facet joints. This is thought to be due to the body's response to try to stop the excess motion at the spinal segment. The bone spurs can become a problem if they start to grow into the spinal canal and press into your spinal cord and nerves.
Symptoms
If the nerves are being sufficiently pinched in the neck, the patient can experience unremitting arm pain, as well as possible balance and coordination problems, due to a cervical stenosis. This pain is generally worse when the patient extends the neck.
If the nerves are being sufficiently pinched in the low back, the patient can experience unremitting buttock and leg pain due to a lumbar stenosis. This pain is generally worse when the patient stands. The pain can interfere with the ability to walk for significant distances.
With degenerative spondylolisthesis, low back pain is the most common symptom, but severe nerve compression can cause numbness, tingling and weakness in the legs. Most symptoms are aggravated by standing, walking and other activities.
Diagnosis
Making the diagnosis of degenerative disc disease begins with a complete history of the problem and a physical examination. The main questions your doctor will be interested in are:
- Where do you feel the pain? What is the intensity?
- When did the pain begin?
- Was there an injury that could be related to the pain?
- Does the pain radiate to other parts of the body?
- What factors make the pain feel better or worse?
- Have you had problems with your bladder or bowels?
- Is there a history of osteoporosis in your family?
After taking your history, the doctor will give you a physical examination. This allows the doctor to rule out possible causes of pain and try to determine the source of your problem. The areas of your body that will be examined depend upon where you are experiencing pain - neck, lower back, arms, legs, etc. The following are some of the things that are checked in a typical exam:
- Motion of Spine and Neck - Is there pain when you twist, bend, or move? If so, where? Have you lost some flexibility?
- Weakness - Your muscles will be tested for strength. You might be asked to try to push or lift your arm, hand, or leg when light resistance is put against them.
- Pain - The doctor may try to determine if you have tenderness of certain areas.
- Sensory Changes - Can you feel certain sensations in specific areas of the feet or hands?
- Reflex Changes - Your tendon reflexes might be tested, such as under the kneecap and under the Achilles tendon on your ankle.
- Motor Skills - You might be asked to do a toe or heel walk.
- Special Signs - The physician will also check for any "red flags" that could indicate something other than spinal/vertebrae problems. Some signs of other problems include: tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (leads to loss of bone mass), or rapid weight loss.
Your doctor will be interested in knowing if you have problems when you urinate or have a bowel movement. This is important to make sure there is no pressure from a spinal disorder on the nerves that go to the bowels and bladder. If you do, this may be an emergency, and require immediate surgery.
Finally, you may be asked to take a variety of diagnostic tests. The tests are chosen based upon what your physician suspects is the cause of your pain. The most common diagnostic tests to determine whether you have a degenerative spine disorder are X-rays of your back and an MRI scan. In some cases, a CAT scan may be ordered either in addition to an MRI or instead of it.
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Excerpts of this article (text/graphics) were provided by
"AllAboutBackandNeckPain.com" DePuy Spine ©2003.
All rights reserved.
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